https://doi.org/10.4081/aiua.2023.10928

Early diagnosis and management of arterio-ureteral fistulas: A literature review

Vol. 95 No. 1 (2023)
Submitted: October 11, 2022
Accepted: November 3, 2022
Published: February 22, 2023
Hematuria, Stents, Urinary fistula, Arterioureteral fistula, Endovascular procedures, Angiography
Abstract Views: 946
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Authors

Pier Paolo Prontera
pierpaolo.prontera@asl.taranto.it
Department of Urology, “S.S. Annunziata” Hospital, Taranto, Italy.
Carmine Sciorio
Department of Urology, “Alessandro Manzoni” Hospital, Lecco, Italy.
Antonio De Cillis
Department of Urology, “S.S. Annunziata” Hospital, Taranto, Italy.
Evangelista Martinelli
Department of Urology, “S.S. Annunziata” Hospital, Taranto, Italy.
Francesco Schiralli
Department of Urology, “S.S. Annunziata” Hospital, Taranto, Italy.
Marco Lattarulo
Department of Urology, “S.S. Annunziata” Hospital, Taranto, Italy.
Angelo D'Elia
Department of Urology, “S.S. Annunziata” Hospital, Taranto, Italy.
Emanuele Utano
Department of Urology, “S.S. Annunziata” Hospital, Taranto, Italy.
Francesco Saverio Grossi
Department of Urology, “S.S. Annunziata” Hospital, Taranto, Italy.

Objectives: Arterio-ureteralfistula (AUF) is an infrequent but potentially life-threatening condition. The aim of this study was reviewing the literature to build a flow-chart useful for an early and effective diagnosis and treatment of this pathology.

Materials and methods: A literature search in PubMed was conducted. In addition, retrieved articles were cross-referenced. Data parameters included oncologic, vascular and urological history, diagnostics, treatment, and follow up were collected using a standard template by 2 independent reviewers.

Results: A total of 140 cases of AUF out of 172 available in the literature at the time of the review, were considered. All patients presented gross hematuria. Chronic indwelling ureteral catheter (CIUC); history of pelvic surgery (HPS) and history of pelvic radiotherapy (HRT) were present respectively in 81%, 62.1%and 58.6% of the sample. The most predominant location of AUF was at the common iliac artery ureteral crossing. Angiography with provocative measures had the highest diagnostic sensitivity (50%) and endovascular treatment with stent-graft placement across the fistula is the current state of the art treatment choice.

Conclusions: Failure to diagnose can postpone a potentially life-saving targeted therapy and lead to complications. The identifi-cation of the Trifecta hematuria, history of pelvic surgery (HPS) and history of pelvic radiotherapy (HPR) would allow the identity-fication of patients at high risk of AUF, who may benefit from more sensitive early diagnostic investigations such as CT angiography and provocative angiography. The treatment of choice in case of AUF to date consist in endovascular prosthesis placement. 

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How to Cite

Prontera, P. P., Sciorio, C., De Cillis, A., Martinelli, E., Schiralli, F., Lattarulo, M., D’Elia, A., Utano, E., & Grossi, F. S. (2023). Early diagnosis and management of arterio-ureteral fistulas: A literature review. Archivio Italiano Di Urologia E Andrologia, 95(1). https://doi.org/10.4081/aiua.2023.10928
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